Expanded endonasal endoscopic approach for resection of a growth hormone-secreting pituitary macroadenoma coexistent with a cavernous carotid artery aneurysm |
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| Authors: | Xuewei Xia Murugappan Ramanathan Brent A. Orr Vafi Salmasi Roberto Salvatori Douglas D. Reh Gary L. Gallia |
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| Affiliation: | 1. Department of Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA;2. Department of Neurosurgery, Affiliated Hospital of Guilin Medical College, Guilin, Guangxi, China;3. Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA;4. Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA;5. Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA;6. Division of Endocrinology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA;1. Gippsland Medical School, Northways Road, Monash University, Churchill, Victoria 3842, Australia;2. Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia;3. Department of Surgery, University of Melbourne, Parkville, Victoria, Australia;1. Department of Neurological Surgery, Division of Neurovascular Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Clinical Office Building, 3rd Floor, Philadelphia, PA 19107, USA;2. Department of Neurosurgery, University of Iowa, Iowa City, IA, USA;1. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States;2. Department of Pathology, Arkansas Neuroscience Institute, St Vincent Infirmary, Little Rock, AR, United States;3. Department of Neurosurgery, Arkansas Neuroscience Institute, St Vincent Infirmary, Little Rock, AR, United States;1. Cancer Research UK, Cambridge Cancer Research Institute, Robinson Way, Cambridge CB2 0RE, UK;2. The Department of Applied Mathematics and Theoretical Physics, Cambridge University, Cambridge, UK;3. Department of Neurosurgery and Brain Tumor and Neuro-Oncology Center, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA;4. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA;1. Department of Neurosurgery and Neurotraumatology, Saint Edvige Provincial Hospital No. 2 in Rzeszow, Lwowska 60, 35-301 Rzeszów, PL, Poland;2. Department of Medical Chemistry, Medical University of Lublin, Chod?ki 4, 20-093 Lublin, PL, Poland;3. Department of Maxillofacial Surgery, Medical University of Lublin, Poland |
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| Abstract: | ![]()
The co-existence of pituitary adenomas (PA) and carotid artery aneurysms has been described and may be particularly frequent in acromegaly. The co-occurrence of an intracranial aneurysm in the setting of a PA presents significant risk to the patient, particularly when the aneurysm is within or near the operative field. We describe a 48-year-old, right-handed female patient with a large skull base lesion who had a left cavernous carotid artery aneurysm detected on her preoperative imaging studies. This patient was managed using a staged approach. She first underwent endovascular stent-assisted coiling of the aneurysm followed, six months later, by resection of the tumor via an expanded endonasal endoscopic approach. Histopathological analysis revealed a pituitary macroadenoma with neuronal metaplasia. Angiographic embolization followed by an expanded endonasal endoscopic approach is a safe and effective treatment for such lesions. Vascular imaging studies and a low index for suspicion are required for preoperative identification of such complex situations. |
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